Delirium in the ICU – a structured review of promising diagnostic and therapeutic approaches: Next steps in ICU delirium

Background: The purpose of this review is to provide a structured overview of emerging diagnostic and therapeutic modalities for delirium in critically ill patients. Methods: Literature searches were carried out to identify relevant articles for both diagnostic and therapeutic approaches other than those included in the 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU guidelines, including prospective and retrospective studies. Results: Regarding diagnostic approaches seven articles were included. The Neelon and Champagne (NEECHAM) Confusion Scale, Stanford Proxy Test for Delirium (S-PTD), and DelApp- ICU yielded excellent diagnostic performances. We included seven articles studying different therapies. Some therapies showed potential to decrease the burden of delirium, using different pathophysiological pathways than antipsychotics. Conclusion: Alternative screening tools may help in ICU delirium detection, either as replacement or combined with the Confusion Assessment Method for ICU (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC), and other therapies than antipsychotics may reduce delirium burden, but further studies are required.